Provider Demographics
NPI:1710099833
Name:VITAL SMILES ALABAMA, P.C.
Entity Type:Organization
Organization Name:VITAL SMILES ALABAMA, P.C.
Other - Org Name:THE TOOTH ZONE II, INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:COMPTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-271-6851
Mailing Address - Street 1:1900 CRESTWOOD BLVD
Mailing Address - Street 2:STE 211
Mailing Address - City:IRONDALE
Mailing Address - State:AL
Mailing Address - Zip Code:35210-2034
Mailing Address - Country:US
Mailing Address - Phone:205-271-6851
Mailing Address - Fax:
Practice Address - Street 1:2302 CENTER POINT PKWY
Practice Address - Street 2:
Practice Address - City:CENTER POINT
Practice Address - State:AL
Practice Address - Zip Code:35215-3608
Practice Address - Country:US
Practice Address - Phone:205-853-9170
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty